Numerous studies have evaluated the effects of the omega-3 fatty acids, DHA and EPA, on cardiovascular health. Overwhelmingly, scientists and clinicians involved in such research believe that omega-3 fatty acids play various beneficial roles in preserving optimal vascular and cardiac health: Anti-Inflammatory, Anti-Thrombotic, Anti-Arrhythmic, and TG-Lowering effects are considered to be the most relevant. Recently, Smith et al. published a fascinating and novel clinical trial looking at a non-cardiovascular yet widespread adverse aspect of aging: muscle mass decline. They published their findings in the American Journal of Clinical Nutrition: Fish oil–derived n–3 PUFA therapy increases muscle mass and function in healthy older adults. All parameters evaluated improved with the administration of 3,200 mg of daily DHA+EPA. Thigh muscle volume, handgrip strength, one-repetition maximum (1-RM) lower- and upper-body strength, and average power during isokinetic leg exercises all demonstrated statistically significant improvement. Improving muscle strength as we age can have far-reaching beneficial consequences that could reduce both morbidity and mortality. Thus, these findings need to be further studied in larger and even more consequential trials. But what additional meaning can we garner from their trial?

I believe that beyond their fascinating and clinically pertinent findings there actually lies a far more evocative message. It is simply that we should be extraordinarily cautious about abandoning the evaluation of therapies (even dietary) when they make biological and physiological sense. Fish oil consumption is woefully low in the US when compared to the far more healthy Japanese population. Our life expectancies are far shorter and various cancers occur more frequently in the US. It is scientifically quite plausible that our deficiency in omega-3 fatty acids plays a significant role in our relatively diminished health. But, after the publication of a few clinical trials failed to demonstrate the cardiovascular benefit of fish and fish oil in select patient populations, some physicians truly abandoned their prior admonitions for patients to augment fish consumption. They were derailed by the controversial results of just a few trials (that many exceptional researchers consider to be flawed in the first place). This type of knee jerk reaction has no place in medicine. It is dangerous and counterproductive. To protect our patients and maintain our scientific integrity, we must always practice with open and attentive minds. Once again I implore my scientific colleagues as well as the oftentimes superficially inquisitive media to follow the science, not the hype.

In medical school we learned about a life threatening form of polydipsia. A subset of patients with schizophrenia consume so much water their sodium can fall to levels unable to sustain life. Twenty liters per day often leads to not just severe illness, but death. How could this be? Water is life’s elixir, and therefore more must be better; correct? Well, simply put, the answer is no. Our kidneys can only handle a water intake of less than one liter per hour. When people exceed this limit, blood becomes diluted; sodium levels fall; and cells swell. As our brain is encased in bone, it has nowhere to go when it swells. Consequently swollen brain cells can lead to permanent damage and even death. It’s not just the unfortunate schizophrenic patients who succumb to such a fate; others do as well. One woman died after drinking six liters in just three hours during a “water drinking competition.” Others have died similarly during college hazing. The point is that a rapid, excessive and unnatural intake of our most vital ingredient for life can kill us in a matter of hours. More is definitely not always better. Aristotle was correct in his dictum of moderation. So where am I going with this you might ask. Let’s consider the most recent “negative” fish oil study by Dr. Voest that was published in a most reputable journal. (For my take on other similar articles please see prior blog posts).

Based upon the fact that some cancer cells can produce long chain fatty acids, Dr. Voest hypothesized that the omega-3 fatty acids in fish could blunt the effect of chemotherapy (such a thought process itself lacks strong scientific validity). Testing his hypothesis he administered 100 microliters of fish oil to 20 gm mice. He was right; fish oil did blunt the effects of chemotherapy. And so his findings were published in the prestigious JAMA Oncology. But let’s look at his study in proper perspective. Ignore the fact that mice are not the optimal animals to study here. Also, ignore the fact that tumor cells produce many substances that have nothing to do with their “desire” to counteract chemotherapy. Simply examine the administered dose. One hundred microliters of fish oil for a 20 gm mouse is equivalent to 400 ml of fish oil for an 80 kg (175 pound) man. Can you imagine guzzling nearly a half-liter of fish oil? The very thought is life threatening! That’s also tantamount to swallowing around 400 fish oil capsules. Who in his right mind would do that? I’d guess no one. The study therefore has no clinical relevance. The author’s conclusion that patients should avoid fish the day prior to receiving chemotherapy has no basis in science. Yet, the study is on the news; patients are concerned that fish causes cancer; doctors who don’t fully understand this area of medicine will become as alarmed as the patients; doctors’ offices will once again be flooded with unnecessary and distracting queries born of inappropriate trial conclusions; and some people who desperately need to consume fish will place themselves in harm’s way by eschewing vital nutrients. The fallout is, and will continue to be, monumental.

Why such studies are done, and why they are published in top-notch journals eludes me. I understand why the media exploits them; they are fodder for ratings. Still, I will continue to proclaim that such studies must be quelled, and the media must become more cautious. It is fine to conjecture, study, and test hypotheses no matter how outlandish they may seem. What is not acceptable however is perpetuating false conclusions as though they are hardened facts. Such a practice – which is prevalent today – leads both doctors and patients astray and pulls us from important issues, those that can truly save lives and help humanity. Let’s get back on track and re-emphasize honesty in medicine as our prime agenda. Honesty should always trump a good story.

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Today most health insurance policies provide yearly health examines and very limited preventive medicine coverage. It’s imperative though that people be proactive in their approach to healthcare to avoid illness and get treatment for on-going conditions before they become serious. People must become their own healthcare advocates.

Here are some basic recommendations:

Get a check-up. How often you have a check-up can be determined by your age, sex and overall health. Have your blood pressure checked and get screened for hypertension.

Stay physically active and exercise regularly. Something as simple as a daily 30-minute walk will do wonders for your overall health.

Weight can be a killer. Address any overweight and obesity issues you may have.

Eat a healthful diet that features daily servings of a variety of fruits and vegetables and at least one serving of fatty fish (salmon, tuna, trout) per week. Consider a high quality fish oil pill that has been concentrated and purified to give you 1,000 mg of combined DHA and EPA in a single soft gel.

Limit foods and drinks high in sugar, salt, and saturated fat. Avoid unhealthful snacks. Stay away from processed foods to the best of your ability. Avoid simple carbohydrates. Sugar is your enemy.

Talk to your doctor about whether or not taking a daily aspirin to prevent heart attacks and stroke is right for you.

Get immunized: Annual flu shots are recommended for adults 50 and older, as well as immunization of adults 65 and older against bacteria that causes pneumonia and related diseases. Children should get immunized for measles, mumps, diphtheria, tetanus, whooping cough, rubella, polio, hepatitis B, etc.

Cholesterol screening is imperative. Request an assessment of not only your LDL but your LDL particle number as well. Liposcience does this in their NMR LipoProfile.

Never smoke; quit smoking if you’ve already started; and avoid second hand smoke.

Adults 50 and older should have a routine colorectal-cancer screening.

Cervical cancer screening for sexually active women and women over 21 years of age.

Routine breast-cancer screening for women 50 and older and discussion with women ages 40 to 49 to set an age to begin screening. Other special recommendations may apply to high risk women. Speak to your doctor.

Calcium-supplement counseling for adolescent girls and women.

Get an eye exam, particularly adults 65 and older.

Please remember that central to overall health is daily exercise, a healthful diet, and maintenance of an optimal weight. We call this TLC, or Therapeutic Lifestyle Changes. TLC is paramount for health!

How many times have we borne witness to the medical recommendations and subsequent reversals and re-reversals of prominent medical societies? In the ‘70s the American Heart Association (AHA) advocated the use of margarine’s hydrogenated oils (trans fats) in place of butter. That, we all now know, was a critical error. The AHA also banned eggs – since reversed – and advocates the use of oils high in omega-6 fatty acids (a recommendation that is currently under significant scrutiny by the scientific community). The AHA has also advised people to eat fish and fish oils. That opinion, still widely held by world leaders in this scientific arena, is now in jeopardy. Last week, Rizos et al published a meta-analysis in the famed Journal of the American Medical Association (JAMA). Rizos findings in a nutshell, omega-3s and fish oil do not help stave off heart disease. There are a number of problems with their trial, but I will limit myself to the two that I consider to be most significant.

First, the statistics. There is a convention in medical science that outcomes are considered to be significant when the p value is < 0.05. In English this means that when the probability that a particular outcome is due to chance is less than 5%, we consider it to be true. A p value of 0.01 (which is less than 0.05) means there’s only a 1% likelihood that a finding is due to chance. This, we consider to be true. On the other hand, a p value of 0.5 means that there’s a 50% possibility that a particular finding is due to chance. We would not consider this finding to be true. You see though, it’s all about possibilities. In reality, we never know that something is true or false, just that it’s likely or not to be true or false. It’s important for you to recognize that our p value designation of 0.05 is considered gospel. Any first year medical student can tell you that. Now consider Rizos’ paper. He performed extraordinarily complex statistical maneuvers and ultimately decided to utilize a p value of 0.0063. That’s correct; he changed convention. By so doing he made the possibility of finding fish oil to be beneficial about 10 times as difficult as it would have been had he stuck to the rules. In fact, had he used a p value of 0.05, the trial would have shown that fish oil indeed does lower cardiovascular death. Instead of the media reporting that fish oil has no value, the headlines would have read, “Take your fish oil. It just might save your life!” That’s because the p value found for cardiovascular death reduction was 0.01, meaning that there is only a 1% possibility that this finding is due to chance, and there is a 99% likelihood it is a real finding! So please don’t stop eating fish or taking fish oil because of this trial’s findings.

Another point of contention is that Rizos described the three cardiovascular benefits of fish oil and omega-3s as: triglyceride-lowering, anti-hypertensive, and anti-arrhythmic. He omitted the two most salient cardiovascular benefits, anti-inflammation and anti-thrombosis (blocking blood clots). He ignored fundamental pathophysiology, an error that I feel can have dire and far-reaching consequences.

In sum, we must not abandon fish oil because of this meta-analysis. So many trials have shown the benefits of omega-3s in myriad medical conditions, such as rheumatologic disorders, cardiovascular disease, macular degeneration, and not least of all, the dementias like Alzheimer’s. Our scientific understanding of the advantages of increasing fish consumption is irrefutable. We cannot afford to repeat the 1970’s misguided AHA initiative for margarine to replace butter. Although doctors on the Today Show and many other popular stations took Rizos’ study at face value and unjustly condemned fish and fish oil, we cannot fall prey to this misinformation.

My advice is to continue your fish and fish oil unless your physician offers a solid reason for you to stop.

I believe one of the keys to enjoying a long and healthful life is a daily program that includes diet, exercise and a regimen of appropriate vitamins, supplements and doctor prescribed medications.

Today I’d like to examine the process of evaluating omega-3 fish oil supplements – products that I believe can enhance and maintain one’s health, and in particular one’s heart health, by potentially reducing the risk of coronary heart disease.

The American Heart Association recommends that individuals with heart disease consume 1000 mg of combined EPA and DHA each day. For those patients who need to lower triglycerides, the AHA recommends 2 to 4 grams of EPA and DHA daily, provided as an omega-3 fish oil supplement in capsule form, under a physician’s care.

With the growing proliferation of omega-3 fish oil products on the market it’s becoming more vital than ever to be an educated consumer. Here are 5 simple things to look for when evaluating a fish oil supplement.

Get the proper dose of EPA and DHA
Choose a fish oil supplement that provides your target dose of combined DHA and EPA (not ALA, omega-6s, or omega-9s). It’s unfortunate that many supplements claim they contain ‘1000 mg fish oils’; a broad term that often misleads consumers who presume the product contains 1000 mg of essential omega-3s, DHA and EPA.

Look for a fish oil capsule that provides the 3:1 ratio of DHA to EPA that replicates the ratio typically found in healthful fish, such as salmon.

Choose a capsule with enteric coating
Choose a capsule that features enteric coating which enhances absorption and typically eliminates any fishy burp or aftertaste. Rosemary extract and vitamin C may be added for superior antioxidant protection.

Choose a purified product
Search out a supplement that has been refined through a process like supercritical fluid technology — a process that gently extracts omega-3s to produce highly concentrated DHA and EPA while most effectively removing contaminants (PCBs, dioxins, furans, and mercury). Also, look for supplements whose manufacturer is certified by international organizations like EMAS, the European standard for environmental care, or similar organizations.

Keeping it green
Choose a fish oil product made from small, non-endangered species of wild fish, such as anchovies, sardines and mackerel, as opposed to those that may be harvesting endangered or over-harvested larger species. Smaller fish also contain fewer toxins that increase in the flesh of larger predatory fish.

Read That Label
Don’t be fooled by labels that claim “1000 mg Fish Oils” but often contain only 30% of the healthful omega-3s, DHA+EPA. The remaining 70% is unnecessary fat. Study the label’s Supplements Facts. How much DHA and EPA are in one serving? How many soft gels make one serving? You might be surprised to learn that you must take 2, 3, or 4 soft gels to get a full 1000 mg of DHA and EPA. If that’s the case, you are getting too much unwanted fat (which can even translate into unintended weight gain).

In sum, be careful about everything you consume. The old adage, “you are what you eat” is definitely true.